A Case of Advanced Gastric Cancer with Intraperitoneal Hemorrhage due to Rupture of the Metastasis Lymph Node

Abstract

A 50-year-old man presented with a sudden-onset left abdominal pain. Contrast-enhanced abdominal computed tomography (CT) revealed a 15-cm mass on the pancreatic body and a large amount of ascites. Intra-abdominal hemorrhage due to rupture of the mass was suspected. As anemia was mild, we examined him for elective surgery. His diagnosis was gastroesophageal junction cancer with lymph node metastasis rupture and para-aortic lymph node metastasis. Surgical therapy was performed in advance, instead of chemotherapy, which might cause tumor lysis syndrome and another hemorrhage. Postoperative chemotherapy is ongoing. Although gastrointestinal bleeding due to gastric cancer is frequently encountered, intraperitoneal hemorrhage due to gastric cancer is quite rare, with only 4 cases reported in which metastasized lymph nodes were enlarged and ruptured. Emergent surgery was selected in 2 cases ; one patient died about one and a half months after the operation due to complications. Sometimes, an expanded surgery to resect a huge metastatic lymph node is necessary. As it is risky to perform an emergent and expanded surgery, careful judgment of timing and procedure is needed.